Abstract
The American Nurses Association (1995, cited by Hamric 1996) characterize advanced practice by: autonomy to practice at the edges of the expanding boundaries of nursing's scope of practice; a preponderance of self-initiated treatment regimens as opposed to dependent functions and greater complexity of clinical decision making; and greater skill in managing organizations and environments (p46) than basic nursing practice. Manley's (1997) notion of expert practice would seem to be implicit in this statement, with her thoughts on the multidimensional nature of advanced practice, where practitioners have a responsibility to develop clinical nursing from clinical to strategic and policy levels contributing a further dimension. Such a definition may facilitate clarity, thus ensuring that the title of ANP is only used to refer to practitioners who can fulfil this role. (Box 4:Reflection item 4.)
There can be no doubt that expansion and advancement in clinical nursing practice is due. This must be considered whilst recognizing that the interests of clients, and their families, and the quality of patient care remain central to service provision. In addition, consideration must be given to the effect on nursing workload and the extent to which nurses can continue to take on additional duties (Mitchinson & Goodland 1996). It may be as Manley (1996) suggests: …that aspects of advanced practice may be intangible and that it is about responding autonomously in ways perceived necessary to develop the service (p 57).
However, establishing ‘new roles’, roles that shift boundaries in professional care, is not as straightforward as it may seem. It takes time and thought, where assessing what is needed, planning, implementation and evaluation requires collaboration between all healthcare professionals; with the foundation of the work based on evidence that includes research studies. Essential to success in meeting any of the recommendations is collaboration between practitioners and educationalists. This will result in the development of education and training programmes that can respond and evolve over time to meet the needs of a developing profession.
In conclusion, this remains a time of indecision. Although discussions are continuing, which will ultimately shape future nursing roles, the whole picture is yet to be revealed. The debate must continue within the literature, and nurses expanding their role or undertaking a new, role have a responsibility to document their development and communicate this to the profession as a whole. Only time will tell whether the profession can define its own role and practice parameters within a constantly changing health care environment.